External Physical Vibration Lithecbole Research Articles

Effect of external physical vibration lithecbole in obese patients with lower pole stones

To investigate the efficacy and safety of external physical vibration lithecbole (EPVL) in obese patients with <15 mm lower pole stones following extracorporeal shock wave lithotripsy (ESWL). Two hundred and ninety-nine obese patients with BMI greater than 30 kg/m2 and lower pole stones smaller than 15 mm were prospectively randomized into two groups. While ESWL was the only option in the control group, patients in the treatment group accepted EPVL after receiving ESWL. Imaging tests were used to compare the stone expulsion status on day 1 and the stone-free rates (SFR) on the first, second, and fourth weekends. All 299 obese patients were randomly divided into two groups, with 152 patients assigned to the treatment group and 147 assigned to the control group. EPVL was effective in facilitating the expulsion of stone fragments. The treatment group's stone expulsion rate on the first day following EPVL was significantly greater than the control group's (66.4% vs. 51.7%, p = 0.009). Stone clearance rates in the treatment and control groups were 63.2 and 55.1% at 1 week (p = 0.041), 84.9 and 70.7% at 2 weeks (p = 0.011), and 90.8 and 79.6% at 4 weeks (p = 0.017), respectively. The complications (hematuria, lumbago, and fever) between the groups did not show any significance (p > 0.05). Patients in the treatment group received an average of 5.2 sessions. EPVL is an efficient and secure procedure that facilitates lower pole stone discharge in obese patients following ESWL treatment. To support the aforementioned conclusions, additional large-scale multi-center prospective studies are required.

Computational Analysis of Influencing Factors and Multiple Scoring Systems of Stone Clearance Rate after Flexible Ureteroscopic Lithotripsy.

Our research aims at the analysis of various stone scoring systems which are referred to as STONE scoring system (SSS) in this study. GUY's scoring system and RUSS scoring system (RSS) are utilized to predict stone-free status (SFS) after surgery and problems after percutaneous nephrolithotomy (PCNL) for harder stones. The data of 68 patients with renal calculi who received FURL in Ren Ji Hospital from Jan 2020 to Mar 2021 are collected as the study subjects. There were 44 male and 24 female patients, with an average age of 55.6 ± 11.4 years. Reliability analysis of related influencing factors (IF) of stone clearance rate (SCR) and multiple scoring systems after flexible ureteroscopic lithotripsy (FURL) was performed. Relevant factors with statistical significance for postoperative SCR were selected for logistic regression analysis (RA). According to the SSS score, GSS classification, and RUSS score, the SCR after FURL was statistically analyzed. The results showed that the P values corresponding to stone position (lower caliceal), cumulative stone diameter (CSD), urinary tract infection, and external physical vibration lithecbole (EPVL) were less than 0.05. The area under the ROC curve of RUSS score, SSS score, and GSS grading was 0.932, 0.841, and 0.533, respectively. The main IF of SCR after FURL were stone location (lower caliceal), CSD, urinary tract infection, and EPVL. The RUSS score system was the best in the evaluation of SCR after FURL. In the previous research, the score systems such as CROES (CRS), SSS, S-ReS, C, and GSS for the prediction of SFS were compared. In our analysis, we have compared the RUSS scoring system which has proven to be giving better results as compared to SSS and GSS. We also performed the regression analysis and found that the stone location shows the strongest correlation of all the other factors for stone clearing rate.

Effect of the External Physical Vibration Lithecbole on the Discharge of Upper Urinary Stones: A Systematic Review and Meta-analysis.

The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR. This study was a systematic review and meta-analysis. A systematic literature review was conducted using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract. In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P < .00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P < .00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23). The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.

Efficacy and Safety of External Physical Vibration Lithecbole After Extracorporeal Shock Wave Lithotripsy or Retrograde Intrarenal Surgery for Urinary Stone: A Systematic Review and Meta-analysis.

Introduction: The current study evaluated the efficacy and safety of external physical vibration lithecbole (EPVL) after extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for urolithiasis. Methods: Publicized literature was systematically searched from EMBASE, Cochrane Library, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science up to February 2020. Fixed-effects or random-effects model was chosen in risk ratio (RR) calculation according to heterogeneity. Quality of evidence was estimated under the guidance of Cochrane handbook. Stone expulsion rate, stone-free rates (SFRs), and complication rates were set as end points. Results: Six randomized controlled trials, including 853 patients, were eligible for analysis. EPVL significantly increased SFR within 3 weeks (RR = 1.17, 95% CI: 1.06-1.29, P = 0.001) and above 3 weeks (RR = 1.19, 95% CI: 1.03-1.37, P = 0.02) after SWL. EPVL also improved SFR within 3 weeks (RR = 1.84, 95% CI: 1.35-2.49, P < 0.0001) and above 3 weeks (RR = 1.53, 95% CI: 1.33-1.77, P < 0.00001) after RIRS. Besides, EPVL can significantly increase SFRs for stones in renal pelvis, lower calix, and multiple locations (all P-value <0.05). Although the overall complication rate was not significantly higher in EPVL + RIRS group, it was found to be 1.38 times higher in EPVL+SWL group (RR = 1.38, 95% CI: 1.06-1.79, P = 0.02), especially the incidence of flank pain (RR = 3.11, 95% CI: 1.02-9.46, P = 0.05). Conclusions: EPVL is effective and safe with high SFRs (especially in renal pelvis, lower calix, and multiple locations) after SWL or RIRS and lower overall complication rate after RIRS in patients with urolithiasis. However, the overall complication rate (especially the incidence of flank pain) was higher after EPVL + SWL.

Clinical study on the treatment of calculous renal colic through external physical vibration lithecbole under different position

Objective: To observe the clinical efficacy of external physical vibration lithecbole (EPVL) in the treatment of calculous renal colic under different positions. Method: A total of 120 calculous renal colic patients who underwent EPVL from September 2018 to September 2019, were randomly divided into three groups utilizing random number table: supine position group, the lateral position group and the hybrid position group, with 40 cases in each group. Prior to the EPVL, each patient was given an intravenous injection of 20 mg furosemide. When the patients accumulated enough urine, they began to undergo EPVL. Numeric Rating Scale (NRS) was applied to assess the pain intensity before and after the treatment. Furthermore, all the patients were examined by B-ultrasound or urinary CT a day and a week after the treatment. The NRS score, side effects, stone discharge rate, time of pain relief, and pain recurrence rate were compared among different groups. Results: Prior to the treatment, there was no significant difference of the pain intensity among three groups (P>0.05). After the treatment, the pain intensity considerably alleviated in all the groups. The NRS score decreased by 4.05±0.24, 3.23±0.23 and 2.90±0.21 in supine, lateral and hybrid position groups, respectively. The time of pain relief was (8.88±0.46) min, (10.33±0.44) min and (10.38±0.50) min in supine, lateral and hybrid position groups, respectively. Overall, the efficacy of lateral position group was better than the other two groups in terms of speed and degree of pain relief (P< 0.05). The total pain relief rate was 91.7%. However, the pain recurrence rate was 15.0% (6/40), 15.0% (6/40) and 12.5% (5/40) in supine, lateral and hybrid position groups, respectively, however, there was no significant difference among three groups (P>0.05). But the hybrid position group had a relatively low rate of pain recurrence. The aggregate stone discharge rate of three groups was 25.8% and 62.5% a day and a week after the treatment respectively. The calculus clearance rate of surgical day was 22.5% (9/40), 35% (14/40) and 20% (8/40) in supine, lateral and hybrid position groups, respectively. Moreover, the stone removal rate was 60% (24/40), 75% (30/40) and 52.5% (21/40) in supine, lateral and hybrid position groups, respectively. The result indicated that the supine position group had the highest stone discharge rate (P<0.05). Overall, there was no case with severe complications, and there was no significant difference of side effects among three groups (P>0.05). Conclusion: EPVL can safely and effectively improve calculous renal colic and assist the removal of stone. When calculous renal colic was treated under EPVL, the patients can benefit from all three positions, and thus it is crucial to decide which position is more appropriate in different scenarios.

Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

BackgroundPhysical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS).MethodsSystematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate.ResultsA total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45–4.66, p < 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection (OR: 0.84; 95%CI: 0.62–1.13; p = 0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21–5.55; p < 0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62–4.81; p = 0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24–5.37; p < 0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01–5.21; p < 0.0001) were both effective in improving SFR when compared to non-intervention.ConclusionsPhysical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy.Trial registrationPROSPERO 2019 CRD42019130228.

External physical vibration lithecbole in treatment of ureteral calculi with renal colic used different positions: a prospective multicenter randomized controlled clinical study

Objective To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic. Methods This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m2), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with low foot high and high foot low respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%. Results A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed. Conclusions The external physical vibration lithecbole adopts high and low position has better effect than head low foot high position in treatment of ureteral calculi with renal colic, and security is acceptable. Key words: Ureteral calculus; Renal colic; Posture; Randomized control research; Multiple center

When is the best time to perform external physical vibration lithecbole (EPVL) after retrograde intrarenal surgery (RIRS): a multi-center study based on randomized controlled trials.

To determine the best time to perform EPVL treatment by evaluating the efficacy and safety of active stone extraction in treating residual fragments at different time points after RIRS. All participants had renal or upper ureteral stones preoperatively and still had residual stones after receiving RIRS. They were prospectively randomized into four groups: patients in group A received EPVL 3days after RIRS; patients in group B received EPVL 7days after RIRS; patients in group C received EPVL 14days after RIRS; patients in group D did not receive EPVL after RIRS. Follow-up examinations were performed on all participants. The results, including stone size and location, stone-free rate (SFR) and complications, were compared among the groups. There were 176 patients in total. The SFR in groups A, B, C and D were 62.22%, 40.91%, 14.28% and 11.11%, respectively, 7days after RIRS. At 14days after RIRS, the SFR was 80%, 59.09%, 42.86% and 26.67% in groups A, B, C and D, respectively. At 28days after RIRS, the SFR was 91.11%, 84.09%, 76.19% and 51.11% in groups A, B, C and D, respectively. Group A had the highest SFR from 7 to 28days, and group C had a higher SFR at 28days after RIRS than group D (P < 0.05). The side effects were less in groups A and B than in group D 28days after RIRS (P < 0.05). We recommended that the best time to perform EPVL is 3days after RIRS, because it could achieve a high SFR at any point in time and reduced complications.

Re: External Physical Vibration Lithecbole Facilitating the Expulsion of Upper Ureteric Stones 1.0-2.0 cm after Extracorporeal Shock Wave Lithotripsy: A Prospective Randomized Trial.

No AccessJournal of UrologyUrological Survey1 Jul 2019Re: External Physical Vibration Lithecbole Facilitating the Expulsion of Upper Ureteric Stones 1.0-2.0 cm after Extracorporeal Shock Wave Lithotripsy: A Prospective Randomized Trial Dean G. AssimosMD Dean G. AssimosDean G. Assimos More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557779.80242.69AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: External Physical Vibration Lithecbole Facilitating the Expulsion of Upper Ureteric Stones 1.0-2.0 cm after Extracorporeal Shock Wave Lithotripsy: A Prospective Randomized Trial." The Journal of Urology, 202(1), p. 27 Suggested Reading : Focused ultrasound to expel calculi from the kidney. J Urol 2012; 187: 739. Link, Google Scholar : Controlled inversion therapy: an adjunct to the elimination of gravity-dependent fragments following extracorporeal shock wave lithotripsy. J Urol 1990; 143: 1096. Link, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 202Issue 1July 2019Page: 27-27 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean G. Assimos More articles by this author Expand All Advertisement Loading ...

External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0\u20132.0\xa0cm after extracorporeal shock wave lithotripsy: a prospective randomized trial

To observe the efficacy and safety of External Physical Vibration Lithecbole (EPVL) in patients with upper ureteric stones 1.0–2.0 cm after extracorporeal shock wave lithotripsy (ESWL). A total of 271 patients with upper ureteric stones 1.0–2.0 cm were prospectively randomized into two groups. One hundred and twenty-seven cases in the treatment group accepted EPVL therapy and 144 cases as control after ESWL. The stone expulsion status and stone-free rates (SFRs) between two groups were compared at the 1st, 2nd and 4th weekends by imaging examinations. All of 271 patients were randomly assigned to two groups, of which 127 patients were included in the treatment group and 144 in the control group. EPVL was successful in assisting the discharge of stone fragments. The rate of stone expulsion at day 1 in the treatment group was significantly higher than in the control group (79.5% vs. 64.6%, P = 0.006). The SFRs of the 1st weekend (76.3% vs. 61.8%, P = 0.010), the 2nd weekend (88.2% vs. 77.1%, P = 0.017) and the 4th weekend (92.1% vs. 84.0%, P = 0.042) in the treatment group were all significantly higher than that in the control group. However, no statistical significance was found in complications between the two groups (P > 0.05). Furthermore, in the treatment group the patients were treated a mean 4.3 sessions of EPVL. EPVL and ESWL are ideal complementary partners in the treatment of upper ureteric stones 1.0–2.0 cm, satisfying both high SFR and low complication. This method is safe and reproducible in clinical practice, and it also needs large-scale multicenter prospective studies further to prove the above conclusions.

The treatment of renal lower pole calculi with flexible ureteroscope and percutaneous nephrolithotomy in obese patients

Objective To evaluate the efficacy and safety of flexible ureteroscopy (FURS) for the treatment of renal lower pole calculi in obese patients. Methods From October 2012 to May 2017, a total number of 184 obese patients(body mass index, BMI≥30) with lower pole kidney stones were randomly divided into two groups, FURS group(n=65) and percutaneous nephrolithotomy(PNL) group (n=119). The mean stone size was (15.8±5.7)mm in FURS group and (18.6±4.9)mm in PNL group. Results All of the D-J stents were removed 4 weeks after operation in both groups, and ultrasonic or X-Ray 87.69% vs. 89.92% (P>0.05). Residual stones were found in 8 vs. 12 patients in each group, and all disappeared after active lithagogue treatment with external physical vibration lithecbole (EPVL). Complications in FURS group were lower than PNL group , including fever(1 vs. 2), pain(8 vs. 23), perirenal hematoma(none vs. 1) , the visual analogue scale/score(3.3±1.1) vs.(5.6±0.9) and hospital stay(3.7±0.6) d vs. (5.4±0.8 ) d was also lower(P<0.05). Conclusions FURS is a safe and efficient option for renal lower pole calculi in obese patients. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopes; Obesity

89 - How to accelerate the upper urinary stone discharge after Extracorporeal Shockwave Lithotripsy (ESWL) for

Objective To asset the efficacy and safety of EPVL plus ESWL compared with ESWL alone for the treatment of simple upper urinary stones (< 15 mm).

Innovation of upper urinary tract stone treatment: from passive to active

Traditional expulsive methods, such as a high fluid intaking, more physical activity and medical expulsive therapy, was aimed at increasing voiding volume, frequency and strength of ureter movement, dilating ureter to detach the stone from mucosa and facilitate the stone clearance. It is usually termed as passive . The external physical vibration lithecbole system has gradually attracted the urologist's attention in recent years. This system develops a simple harmonic to drive the stone explusion along the urinary tract, which was named this new concept as active . The clinic safety and efficacy of active lithecbole has been proved during recent 5 years. In this paper, we reviewed the treatment of upper urinary tract stone from passive lithecbole to active lithecbole, and discussed the innovation of this concept altering. Key words: Upper urinary tract stone; Conservative treatment; Passive lithecbole; Active lithecbole

External Physical Vibration Lithecbole Promotes the Clearance of Upper Urinary Stones after Retrograde Intrarenal Surgery: A Prospective, Multicenter, Randomized Controlled Trial

We assessed the efficacy and safety of external physical vibration lithecbole for the treatment of residual stones after retrograde intrarenal surgery. A total of 173 patients (128 males and 45 females) were selected for study. All patients had residual fragments after retrograde intrarenal surgery for renal or upper ureteral stones. They were prospectively randomized into 2 groups. One group underwent external physical vibration lithecbole 1 week after retrograde intrarenal surgery and the other underwent only retrograde intrarenal surgery as the control group. Stone size and location, stone-free rate and complications were compared. Of 173 patients 87 (66 males and 21 females) were in the treatment group and 86 (62 males and 24 females) were in the control group. The stone-free rate in the treated and control groups 2 weeks after retrograde intrarenal surgery was 52.9% and 31.4%, at 3 weeks it was 71.3% and 51.2%, and at 5 weeks it was 89.7% and 59.3%, respectively (all p <0.05). The hematuria incidence 5weeks after retrograde intrarenal surgery was 3.4% in the treated group compared to 20.9% in the control group (p <0.05). The incidence of positive urine leukocytes in the treated vs control groups was 4.6% vs 19.8% 3 weeks after retrograde intrarenal surgery and 3.4% vs 11.6% at 5 weeks (p <0.05). External physical vibration lithecbole as a supplement to retrograde intrarenal surgery was more effective than retrograde intrarenal surgery alone in terms of stone clearance speed, stone-free rate and patient compliance.

The efficacy of external physical vibration lithecbole in the assistant treatment of the upper urinary tract residual stones: a meta-analysis

Objective: To determine the clinical effect of Friend-Ⅰ External Physical Vibration Lithecbole (EPVL) by Meta-analysis. Methods: Pubmed, Embase, Medline, Cochrane Library, Chinese National Knowledge Infrastructure were searched for clinical trials comparing EPVL with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by Review Manager 5.3 software. Results: Five randomized or Quasi-randomized controlled trials met the inclusion criteria. The first day stone expulsion rate of EPVL group was superior to the control group (OR=4.95, 95% CI: 3.35-7.32, P<0.000 01). Both one-week (OR=3.13, 95% CI: 1.95-5.04, P<0.000 01) and two-week stone free rate (OR=4.50, 95% CI: 2.02-10.00, P=0.000 2) were statistically higher in the EPVL group than that in the control group. No severe adverse event occurred during the follow-up. Conclusions: Our study suggested that EPVL could be the effective treatment for upper urinary tract residual stone. However, more high quality randomized controlled trials are needed to better affirm this.

A Prospective Randomized Controlled Trial of the Efficacy of External Physical Vibration Lithecbole after Extracorporeal Shock Wave Lithotripsy for a Lower Pole Renal Stone Less Than 2 cm

We evaluate the efficacy and safety of external physical vibration lithecbole in improving the clearance rates of lower pole renal stones after shock wave lithotripsy. A total of 71 patients with lower pole renal stones (6 to 20 mm) were prospectively randomized into 2 groups. In the treatment group 34patients were treated with external physical vibration lithecbole after shock wave lithotripsy. In the control group 37 patients underwent shock wave lithotripsy only. External physical vibration lithecbole was performed without anesthesia by the same team using the Friend-I External Physical Vibration Lithecbole (Fu Jian Da Medical Instrument Co., Ltd, Zhengzhou, China). The stone-free rate, stone expulsion rate, stone expulsion time and incidence of complications were monitored. External physical vibration lithecbole was successful in assisting the discharge of stone fragments. The stone-free status was 76.5% in the treatment group and 48.6% in the control group (p=0.008). Stone expulsion rates at day 1, week 1 and week 3 were 76.5% (26), 94.1% (32) and 94.1% (32) in the treatment group vs 43.2% (16), 73.0% (27) and 89.2% (33) in the control group, respectively. Mean stone fragment expulsion time was 11.2 minutes in the treatment group and 9.17 hours in the control group (p=0.016). There was no significant difference in complications between the 2 groups (p >0.05). External physical vibration lithecbole was efficacious in assisting the discharge of lower pole renal stone fragments and can be used as an adjunctive method of minimally invasive stone treatment. However, additional investigations are needed to confirm the efficacy.

AB094. Upper urinary stone management in China

ObjectiveTo give an overview of the contemporary management for upper urinary stones in China.MethodsContemporary treatment methods, especially novel or developing modality with Chinese characteristics, for upper urinary stones in China has been reviewed and introduced.ResultsUrolithiasis is one of the most prevalent diseases in the urologic clinic and usually affects people aged 20 to 60 years. In recent years, the overall morbidity of urolithiasis in Chinese population has increased with a significant reduction of lower urinary stone and an increase of upper urinary stone. Upper urinary stone may induce more severe complications and have been considered to be the main cause of nephrectomy besides urinary tumor. The management of upper urinary stone can be challenging somehow. Extracorporeal shock wave lithotripsy (ESWL) is usually the first choice for patients with simple upper urinary stone sized 2 cm or less. Recent years, according to the mechanism of lithecbole by vibration and body position, some Chinese urologists have developed a novel machine, external physical vibration lithecbole (EPVL), which can facilitate removal of urinary stone after ESWL or endoscopic lithotripsy. The combination of EPVL therapy with ESWL or endoscopic lithotripsy significantly improves the stone-free rate. Percutaneous nephrolithotomy (PCNL) is increasingly employed as a major modality for patients with large and complex upper urinary stone. The minimally invasive PCNL (mPCNL), which was performed with a miniature endoscope by way of a small size tract (12-20 F), could decrease morbidity, especially uncontrolled hemorrhage. However, its efficiency of removing stone fragments is lower. The Chinese urologists have modified PCNL technique by using an 8/9.8 F rigid ureteroscope through the 14-18 F percutaneous tract under the guidance of ultrasound or X-ray. The results from a series of studies demonstrate that Chinese mPCNL is a safe, feasible and efficient method for treating upper urinary stone with a low complication rate. With the development of technology, flexible ureteroscopy has become one of the main actors in clinical practice over the past several years. Flexible ureteroscopy can reach most parts of the kidney so that all stones can be removed or vaporised provided they are of an appropriate size and accessible. Moreover, flexible ureteroscopy is well tolerated and effective which allows us to obtain a high success rate, low morbidity, and a brief hospital stay. It could be the best option in managing the special patients with multiple intrarenal stones, stone-bearing caliceal diverticula, anticoagulated history, obesity, anomalous kidneys and pregnancy, which are not applicable for ESWL or PCNL. However, the flexible ureteroscopy is much more difficult to handle than the rigid ureteroscope. In addition, the flexible ureteroscope is expensive and easy to be damaged or broken, the treatment cost usually higher than ordinary treatment. In the past decades, some Chinese urologists and engineers have put in a great effort to design novel types of flexible ureteroscope which is cheaper and easier to operate. The integrated flexible and rigid ureteroscope is one of the new designed instruments of which the body is an ordinary rigid ureteroscope but have a flexible end. This novel device could be operated as easy as rigid ureteroscope and the end of ureteroscope could move flexiblely after its entry of the renal pelvis. Several different types of the Chinese flexible ureteroscope have completed the clinical trials and are going to be commercially available.ConclusionsGenerally, upper urinary stone is one of the most common diseases in urologic department in China and some novel treatment methods with Chinese characteristics has been developed. Each treatment method has advantages and disadvantages. The urologists’ choice of the treatment strategy should be made individually according to the properties of stone and the patient’s body condition.

Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy

Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment. Key words: Lithotripsy; External physical vibration lithecbole; Calculus of upper urinary tract; Stone expulsion rate; Stone free rate

In Vitro Comparison of Prototype Magnetic Tool with Conventional Nitinol Basket for Ureteroscopic Retrieval of Stone Fragments Rendered Paramagnetic with Iron Oxide Microparticles

We developed a prototype magnetic tool for ureteroscopic extraction of magnetized stone particles. We compared its efficiency for retrieving magnetized calcium oxalate monohydrate stone particles with that of a conventional nitinol basket from the pelvi-collecting system of a bench top ureteroscopic simulator. Iron oxide microparticles were successfully bound to 1 to 1.5, 1.5 to 2 and 2 to 2.5 mm human calcium oxalate monohydrate stones. Several coated fragments of each size were implanted in the collecting system of a bench top ureteroscopic simulator. Five-minute timed stone extraction trials were performed for each fragment size using a back loaded 8Fr magnetic tool mounted on a 0.038-inch guidewire or a conventional basket. The median number of fragments retrieved per timed trial was compared for the magnetic tool vs the basket using the Mann-Whitney U test. For 1 to 1.5 mm fragments the median number retrieved within 5 minutes was significantly higher for the prototype magnetic tool than for the nitinol basket (9.5 vs 3.5, p = 0.03). For 1.5 to 2 mm fragments the magnetic tool was more efficient but the difference in the number of fragments retrieved was not statistically significant (9.5 vs 4.5, p = 0.19). For 2 to 2.5 mm fragments there was no difference between the instruments in the number retrieved (6 per group, p = 1.0). The prototype magnetic tool improved the efficiency of retrieving stone particles rendered paramagnetic that were less than 2 mm but showed no advantage for larger fragments. This system has the potential to decrease the number of small retained fragments after ureteroscopic lithotripsy.

MECHANICAL PERCUSSION, INVERSION AND DIURESIS FOR RESIDUAL LOWER POLE FRAGMENTS AFTER SHOCK WAVE LITHOTRIPSY: A PROSPECTIVE, SINGLE BLIND, RANDOMIZED CONTROLLED TRIAL

We compare the effectiveness of mechanical percussion and inversion with observation for eliminating lower caliceal fragments 3 months after shock wave lithotripsy. At 3 months after shock wave lithotripsy 69 patients with residual lower caliceal fragments 4 mm. or less were randomized to receive either mechanical percussion and inversion or observation for 1 month. The observation group then received crossover mechanical percussion and inversion if fragments persisted. All patients were followed with plain film of the kidneys, ureters and bladder to assess the stone area and stone-free status, and renal tomography or noncontrast spiral computerized tomography to confirm stone-free status. A blinded radiologist reviewed all films. Patients were treated with a mechanical chest percussor applied to the flank while inverted to greater than 60 degrees after receiving 20 mg. furosemide. A total of 35 patients were randomized to receive immediate mechanical percussion and inversion therapy and 34 observation. Of the patients in the observation group 28 subsequently received mechanical percussion and inversion after completing the observation period. The groups were not different in gender, body mass index, side affected, stone location or renal anatomical features. The mechanical percussion and inversion group had a substantially higher stone-free rate than the observation group (40% versus 3%, respectively, p <0.001). The mechanical percussion and inversion group also had a greater improvement in total stone area than controls (-63.3% versus +2.7%, respectively, p <0.001). No significant adverse effects were noted in the mechanical percussion and inversion group. Mechanical percussion and inversion is a safe and effective treatment option for residual lower caliceal fragments 3 months after shock wave lithotripsy. Nearly 50% of patients become stone-free, and stone burden is decreased by 50% in the remainder.